HSM is a flagship program that is managed by Way to Health. As the article details, the program has been through multiple iterations and now is the standard of care across all of Penn Medicine and increasingly in other intitutions in the country. The efficacy of the program has been proven in multiple clinical trials and has shown reduction in readmissions by up to 80%.

Some of the key learnings from the pandemic from across the center. Learnings include risk evaluation changes (allowing texting), telemedicine being the lifeline and its future growth, things getting done quickly given a crisis, remote work is here to stay and is a good thing, and the need for an increased emphasis on mental health.

The Watch program was built to monitor patients exhibiting COVID or COVID like symptoms and were not deemed to be serious enough to be admitted to the hospital. The program regularly checked in with the patient and if necessary, was escalated to receive care immediately. The results continue to seen and as the article mentions, "We found that overall mortality was less than 1% in both groups at 60 days. However, five of 3,448 (0.14%) COVID Watch patients died compared to 16 of 4,377 (0.37%) patients who received usual care. After risk adjustment, this is 2.5 fewer deaths per 1,000 patients enrolled and a 66% lower odds of death."

This write up by the Center for Applied Health Informatics at Penn about the multi-pronged approach taken by Penn Medicine to enable broad and equitable vaccine distribution and availability. Approaches included leveraging the patient portal, emails, phone calls and text messages as well as neighborhood vaccine clinics in partnership with the communities and the city of Philadelphia

Another write-up on the effectiveness of COVID Watch. The simplicity of the program combined with a backend of on-demand 24x7 nursing staff and clinicians (up to a amximum of 7 during the height of the pandemic) led to significant mortality reduction as detailed [here](https://www.acpjournals.org/doi/10.7326/M21-2019). The program was designed and continues to run on Way to Health and has managed over 20,000 patients thus far. In summary, it reduces the odds of mortality by 68% by connecting with patients sooner and getting them into the hospital asap when appropriate.

A write-up on the efficacy of COVID Watch based on [this](https://www.acpjournals.org/doi/10.7326/M21-2019) recently published analysis on the effectiveness of the program. The program was designed and continues to run on Way to Health and has managed over 20,000 patients thus far. In summary, it reduces the odds of mortality by 68% by connecting with patients sooner and getting them into the hospital asap when appropriate. At the height of the pandemic, the data indicates that the program was saving at least one life every other day.

A retrospective on vaccination related disparities and the vaccination clinics W2H empowered from the perspective of a clinician. While we made things low / no-tech, it took a lot of tech in the background to make it seem as such. Perhaps that is the key learning, tech should be invisible and be there to support the process, not change it.

More coverage of the Community vaccination clinic efforts being undertaken at Penn Medicine in collaboration with Mercy Health and community organizations - faith based, schools and more. #intentionaleffort.

Great article on Watch specfically and texting programs in general that have helped keep patients safe and out of the hospital. Patients appreciate the ability to stay home but still monitored and connected to care teams, while the clinicians are comfortable that issues can be identified and addressed quickly and efficiently. Automation also saves the health system serious money, reducing the need for additional staffing. While some technology worsens disparities, simple texting programs appear to close the gap.

Quoting from the site - Despite more and more people becoming eligible for vaccination, it seems like vaccine distribution is operating way below “warp speed.” Sam talked to an independent pharmacist and the Director of the Penn Medicine Nudge Unit to see how the government could step up their game.

Further coverage on the Flu vaccination mega study in Forbes. Here's a quote from the article - The researchers are optimistic that that what they've learned about the flu will help with COVID. "Our results suggest a promising way to encourage COVID-19 vaccinations at scale—we can potentially help save lives for less than 10¢ per person,” said Katy Milkman, Wharton professor, BCFG Co-Director, and lead author on the study. In the end, said Mitesh Patel, Penn Medicine Professor and PMNU Director, such seemingly small tweaks could "nudge vaccination rates higher and help us end this pandemic faster.”

At Penn Medicine and Geisinger, BCFG conducted its study in collaboration with Christopher Chabris and Michelle Meyer (co-directors of the Geisinger Behavioral Insights Team). In the fall of 2020, close to 50,000 patients received one of 19 different messages prior to a healthy visit to their primary care provider. In the new study, roughly a third of the messages BCFG tested significantly increased flu shot uptake. The Penn and Geisinger studies were fully powered by Way to Health including integrations with the respective Epic based EHRs.

After a rapid mobilization of its telemedicine infrastructure to ensure continuity of care for patients of all kinds during the hectic days of March 2020, Penn Medicine marked telemedicine visit number one million this week. COVID Watch has contributed in it's own small way by taking care of over 15,000 patients remotely.

Philadelphia data says African-Americans have the highest infection, hospitalization, and death rates in the city but only account for about 18% of vaccinations. Penn Medicine and the entire team partnered around this. Way to Health enabled the low tech / no-tech approach to try and insure maximum uptake.

More than 500 people registered to get vaccinated at a West Philadelphia church on Saturday, the first of three planned mass vaccination sites created by area hospitals in partnership with neighborhood faith leaders. This was done in partnership with multiple faith based and health care organizations - including Penn Medicine and Mercy Health. “We set forth on creating a clinic that would promote accessibility while using novel principles of no/low tech to ensure we would provide an environment in a day when anyone and everyone would have access to it,” said Dr, Kathleen Lee. “And use this concept to inform additional clinics.” W2H is proud to have supported this low tech / no-tech effort.

Researchers saw a fourfold decline in the rate of patients who needed to go back to the hospital after total hip or knee replacements if they were enrolled in a program that used wearable step counters and conversational text messaging to keep tabs on recovery. The study was published in JAMA Network Open

Dr. Jessica Dine, a lung doctor at Penn Medicine in Philadelphia, said she began noticing a subset of COVID-19 patients whose symptoms lingered long after their diagnoses thanks to a hospital program called COVID Watch, a texting service that does daily check-ins with COVID-19 patients at home.

As we continue our fight against COVID-19, healthcare leaders and innovators are at the forefront of this battle to ensure we are equipped with the right arsenal to overcome one of the biggest public health crises of our lifetimes. Dr. David Asch, Executive Director of the Penn Medicine Center for Health Care Innovation, and his team are among the leaders creating and implementing game-changing innovations during this pandemic. In this podcast, he dives deeply into Penn Medicine’s COVID Watch technology and their COBALT program.

Penn Medicine ’s COVID Watch team has received a $2.5 million grant from the Patient-Centered Outcomes Research Institute (PCORI) to study the program’s impact, particularly among Black and Latinx patients whose communities have endured significant disparities during the pandemic.

A write up on all the ways in which the Center for Health Care Innovation partnered with multiple groups across the health system to address pressing needs around remote monitoring, ED contactless registration, text-ins and more. Way to Health played a central role in multiple of these efforts.

Patients can refrain from seeking care because of worries of contracting COVID-19. Penn developed a series of programs including COVID Watch to help alleviate this concern for both patients as well as physicians.

PennHealthX interviews medical director Anna U. Morgan MD about the challenges of implementing COVID Watch, and how patients have been responding.

Penn Medicine’s COVID Watch system lets the health care team check up on a patient with just a couple of text messages each day. Two texts are sent out daily with a couple of questions designed to assess the patient’s medical condition.

“We are going to have a lot of patients with coronavirus sheltering in place, and we need to give them the reassurance that Penn Medicine is watching over them,” said David Asch, MD, executive director of the Penn Medicine Center for Health Care Innovation, reflecting on the thought process behind the tool’s development beginning in early March.

According to a new Penn Medicine Study, doctors who track their patients’ physical activity might have more luck doing it with smartphones than wearable fitness devices. “Most people with smartphones take them everywhere they go. Since carrying the phone is already a built-in habit, it makes it much easier to use the device to track activity levels,” says Mitesh Patel, the director of Penn Medicine’s Nudge Unit. Read on to find out how this improves remotely monitoring patient behaviors.

What is the role of human behavior in healthcare? Looking at both patients and physicians, David Asch discussed at the Siemens Healthineers Executive Summit 2019 the science of motivation and the role played by education, rewards (including financial incentives), and simple design changes in technology in transforming care delivery.

A team at Penn Medicine may have found a way to save hundreds of new moms’ lives with a simple—but incredibly effective—tool. A write-up of the success of the Heart Safe Motherhood program powered by Way to Health which goes into a lot more detail about the program, its origins, success to date and future plans

"Successful innovation requires experimentation," the article's authors concluded. "But healthcare change requires we tinker with the healthcare system we depend on, affecting critical resources organizations understandably protect. To support the people determined to drive change quickly, we need to find ways to bend institutional norms safely." Authors include David Asch, Roy Rosin and Kevin Mahoney. Several of the programs referenced use Way to Health.

Another reference the JAMA study using Way to Health. “Most interventions are designed as one-size-fits-all, in which a single intervention is deployed to a large population,” said Patel. “Even if the program works on average, many participants may not benefit. Our next step will be to use data from this trial to develop behavioral profiles that could be used in the future to match the right intervention to the right person.”

The Health Federation of Philadelphia and its partners plan to increase women’s access to childbirth coaches called doulas. Another piece of the plan involves sending new mothers who have cardiovascular disease home with a blood pressure monitor and phone app, called Heart Safe Motherhood, developed at the University of Pennsylvania.

“We found that a behaviorally designed gamification program led to significant increases in physical activity compared to a control group that used wearable devices alone. During the nine-month trial, the average person in the competition arm walked about 100 miles more than the average person in control.” says Mitesh Patel, the director of Penn Medicine’s Nudge Unit and an assistant professor of medicine and health care management.

Interview by lead author - Shivan Mehta, on success of the ColoPrep study.

Years of treating people who have been hurt in distracted driving crashes is a big reason why Delgado is researching this topic. He’s heading up a multimillion-dollar grant, one of the largest ever funded by the federal government, to figure out the best ways to use technology to help drivers put down their phones. The research team includes experts from the fields of medicine, behavioral economics, psychology, insurance and technology. They hope their work leads to the development of more smartphone programs that can nudge drivers into the correct behavior, like apps that automatically switch on to prevent incoming notifications while in the car.

Way to Health co-founder, Steering Committee member and executive director at the Penn Medicine Center for Health Care Innovation, Dr. David Asch is interviewed about behavioral economics, medication adherence, loss framing, patient and clinician behavior, and more.

“We wanted to really focus on people for whom access to available smoking cessation interventions tends to be least, because that’s where the health consequences tend to be greatest.” said Dr. Scott Halpern. The Vitality study and an upcoming pragmatic trial both run on Way to Health.

As healthcare organizations strive to keep up with changes in the medical world, Penn Medicine in Philadelphia is taking its own approach to innovation with the help of a homegrown platforms that seek to help improve patient care such as Way To Health. The platform, Way to Health, can collect data from various sources, including scales, Fitbits, connected pill bottles and patient texting. Through it, Penn Medicine can stay connected to patients after they leave the premises. The name of the tool — Way to Health — is actually a nod to the history of Philadelphia, as Benjamin Franklin wrote an essay called “The Way to Wealth.”

Another success of the Heart Safe Motherhood program powered by Way To Health. The text messaging system increased the compliance rate to 93%, compared with just 30% of those asked to return to the office after hospital discharge. Just as importantly, it completely erased racial disparity in compliance rates, compared with white women, with more than 90% of both groups complying.

A texting-based intervention, where women texted in their blood pressure measurements versus coming in for a postpartum office visit, virtually eliminated racial disparities in postpartum care further highlighting the need to design interventions that are easily accessible by everyone.

As opioid addiction has reached crisis proportions, surgeons in a variety of fields have worked to reduce the need for opioids after procedures, in the hope that fewer patients would become dependent on or addicted to pain pills.. A comprehensive program designed to improve the quality of care for spine and peripheral nerve surgery patients reduced patients' opioid use at one month after surgery without increasing pain.

Most research has shown that wearable devices and activity monitors are not that accurate for measuring energy expenditure

Only five percent of American adults actually use wearable and further, half of people who purchase wearables quickly stop using them.

Wellness programs are increasing in popularity as companies grow more determined to curb the soaring costs of providing health insurance for employees. To encourage healthy behaviors, firms are offering everything from free yoga classes to weight-loss support groups. While there have been some positive results from these programs, smoking cessation remains a particular challenge. A recent study by Dr. Kevin Volpp and Dr. Scott Halpern - [Vitality Smoking](https://www.waytohealth.org/casestudies/vitality-smoking/) shows significant promise and was discussed in this Knowledge @ Wharton podcast.

Combining financial incentives, personalized goal setting and wearable devices might be an effective way of encouraging heart disease patients to engage in more physical activity. During the 9 to 16-week period, patients in the intervention increased their steps by 1,368 more steps per day than patients in the control group. After financial incentives were stopped at 16 weeks, participants in the intervention still had an increase of 1,154 steps per day more than the control group over the ensuing eight weeks.

A new study published in the Journal of the American Heart Association said the trackers — when paired with a little cold, hard cash — might just give people that push to start a regular exercise routine. “Framing rewards as a loss — a technique from behavioral economics — led to a meaningful difference in behavior,” said Dr. Mitesh Patel, an assistant professor of medicine and health care management, and director of the Penn Medicine Nudge Unit. “During the six-month trial, the average patient in the intervention arm had step counts that totaled about 100 miles more than the average patient in control.”

Given the urgency of the opioid epidemic, the latest round of connected health pilot programs run by CHIBE in conjunction with Penn’s Clinical and Translational Research Award (CTSA) – which is based at Penn’s Institute for Translational Medicine and Therapeutics (ITMAT) – prioritized pilot projects focused on reducing harm from opioids. As Dr. Kevin Volpp noted, “If the ideas we test are sufficiently bold, some will likely be unsuccessful, but that’s okay if across projects we make progress.”

This is the Active Reward study. "Framing rewards as a loss -- a technique from behavioral economics -- led to a meaningful difference in behavior," said Dr. Mitesh Patel, an assistant professor of Medicine and Health Care Management, and director of the Penn Medicine Nudge Unit. "During the 6-month trial, the average patient in the intervention arm had step counts that totaled about 100 miles more than the average patient in control."

This is the Vitality Smoking study. A recent study published in the New England Journal of Medicine looked at different strategies to quit smoking, and while it found that none of them work all that well, even in conjunction, a multi-faceted approach works best. The study found that offering a reward of $600 to quit for six months increased success rates two-fold, or three-fold in some sub-groups.

This is the Vitality Smoking study. E-cigarettes aren’t just hipster-y and cloying—they also may not actually help people quit smoking. That’s according to a new study that found that e-cigarettes weren’t any better than other methods of smoking cessation, and the only thing that really works is paying people to quit.

Summary of NEJM article re smoking cessation. The new Penn study enrolled more than 6,000 people from 54 U.S.-based companies. Offering free pharmacological therapy or ecigs did not increase tobacco cessation; financial incentives tripled rates of cessation. Study was run on Way To Health

In a large study of company wellness programs (The Vitality Smoking Cessation Program run on Way To Health) released on Wednesday, May 23, 2018, e-cigarettes worked no better than traditional stop-smoking tools, and the only thing that really helped was paying folks to kick the habit.

David Asch, MD gave a keynote address at the Osteoarthritis Research Society International World Congress (OARSI) about how understanding the incentives that drive human behavior may be useful in helping patients with osteoarthritis improve health-related habits. "Once you accept that people are irrational, it gives you better opportunities to help them".

"Fitbits and pedometers don't make you walk more," said Asch. "Weight loss apps don't make you lose weight. They're just facilitators. Unless they're paired with some insight into human behavior, they're the sound of one hand clapping."

People don't use activity trackers as much as prior surveys indicate. Incenting people to do the right thing has always been a challenge. David Asch and Mitesh Patel discuss ways in which personalization, behavioral economics and gamification can perhaps be used to nudge individuals to pay more attention to their health.

David Asch, MD keynoted the HIMSS '19 Digital and Personal Connected Health Conference. Key quotes included - “Innovation is like research. It’s hypothesis-driven, it’s falsifiable and it’s highly disciplined.” “Often we are solving for the wrong problem, and if we solved for the right problem we might be in a better position to address our customers’ needs".

Medicare spending accounted for 15% of federal spending in 2016. It is projected to reach 17.5% of federal spending by 2027. If we are to slow the rate of growth in Medicare spending over the longer term, it will likely require some unpopular limits on beneficiary access, convenience, and generosity of coverage.

Highlights the importance of also sharing the losses along with the wins - "*In large part, I am happy because it got published in a leading medical journal: JAMA Internal Medicine. Kudos to the editors for publishing a “failed" trial. Trust me, there’s no failure in doing good science. The real failure would have been to allow this important study to go unpublished because the intervention didn’t work*".

But there aren’t a lot of fitness trackers infused with legitimate behavioral science, says Patel. While plenty of apps use gamification strategies, those strategies tend to be ill-conceived, based on standard economics and the idea that people are rational. “They think about all the different possibilities, and ‘How much will this cake or this gym workout add to my overall life,’ and then make a decision,” Patel says. “But we know people don’t do that.”

"Fitbits and pedometers don't make you walk more," said Asch. “Weight loss apps don't make you lose weight. They're just facilitators. Unless they're paired with some insight into human behavior, they're the sound of one hand clapping."

Opportunities for effective nudges abound in health care because choice architectures guide our behavior whether we know it or not. As more health care decisions are made within digital environments where they can be witnessed and their context can easily be reshaped, nudging opportunities expand. It doesn’t take much investment to support such expertise, and given the value of its applications, most health systems would be well served by insourcing it. We owe it to our patients to do the same for health care.

Anti-smoking advocates need to disseminate advice about effective behavior change strategies and encourage health plan benefit designs that invest in preventing disease, as opposed to simply treating the health consequences of smoking.

A vision for the future casts the visit to the primary care doctor not as the solution but as a kind of failure—an inability to accommodate patient needs by any of the less-expensive levels of support.

Programs to improve health for employees focus on common-sense approaches such as quitting smoking and maintaining a healthy weight.

The Maryland Health Care Commission, the state’s independent regulatory agency, is unveiling a website on which people scheduling a hip replacement, knee replacement, hysterectomy or vaginal delivery can see price differences among different providers for the same procedure.

A team at the University of Pennsylvania Perelman School of Medicine is harnessing the convenience of smartphones, wireless blood pressure monitoring technology, and electronic health records (EHRs) to more closely monitor the blood pressure of postpartum patients after they go home from the hospital.

Smoking, savings, honesty, and healthy eating may not be items on your list of problems to address or areas where you’d like to see improvements in your own behavior or the actions of people you manage or lead. But no matter what concerns you, adopting a nudge, as Thaler and the many scholars who followed his approach to research tell us, may lead to a powerful change for the better. It just requires an acknowledgment that human behavior is full of anomalies.

The family that plays an online game together may get more exercise together, a new study suggests. But more research needed because study participants were all white, and wealthier than most Americans

Christian Terwiesch, a Wharton professor of operations, information and decisions, has co-authored two new studies related to technology and health care. The first, which examined the impact of e-visits on primary care, found some surprisingly negative results about connectivity: E-visits can take up more of a physician’s time rather than making patient contacts simpler and more efficient. That has contributed to more physicians feeling overburdened and burnt out, with less ability to take on new patients. The second paper looked at how some of those negative effects could be turned around. Terwiesch sat down with Knowledge@Wharton to talk about these topics, which he describes as a “hot area” that sits at the intersection of medicine and management.

Fitbits and smartphone apps can aid in managing chronic conditions — but only if people stay engaged.

Humans are social animals, and providers can use those social connections as a driving force for better patient engagement. Peer support and coaching programs can lead to better care management for patients with chronic conditions, for example, said David A. Asch, M.D., executive director of Penn Medicine Center for Health Care Innovation, and Michele E. Heisler, M.D., professor of internal medicine and health behavior at the University of Michigan, during an event hosted by NEJM Catalyst.

A more complete view of human behavior seems necessary for more effective medicine. Health is fundamentally the product of myriad daily decisions made by doctors and patients, and by uncovering what truly motivates us, we may be able to nudge one another toward wiser decisions and healthier lives.

The promise of behavioral economics for health is that many of the same messages, incentives, and choice structures used so effectively to lure people into situations where they may be exploited can be redirected to attract them to healthier choices that improve their well-being. Health programs are more likely to be successful if designed not based on how perfectly rational people ought to make health decisions but on how humans actually make them.

The real problem here is not economics or behavioral economics or psychology. It is obesity. Losing weight is insanely hard to do. And keeping weight off is even harder.

Health care organizations, newly focused on population outcomes, can develop and test social interventions for advancing health. Given the increasing evidence that behavior is contagious, there’s good reason to believe that such models could work. You are more likely to smoke if people close to you smoke — and more likely to quit if they quit. Yet most health care interventions are designed for the individual. For some time, doctors have recognized that some patients’ social connections have a beneficial effect on their health. Now, doctors and hospitals can develop new approaches to prescribe social engagement for everyone else.

A team at the University of Pennsylvania Perelman School of Medicine is harnessing the convenience of smartphones, wireless blood pressure monitoring technology, and electronic health records (EHRs) to more closely monitor the blood pressure of postpartum patients after they go home from the hospital.